If your child has the symptoms of Kawasaki’s Disease, call your doctor right away. Your doctor will first try to rule out other diseases that have similar symptoms, such as scarlet fever, Rocky Mountain spotted fever and juvenile rheumatoid arthritis.
Children who have Kawasaki’s Disease require hospital treatment to prevent damage to the coronary arteries and heart. Treatment with a single dose of intravenous gamma globulin (a high concentration of purified antibodies) is most effective when given within 10 days of the start of the fever.
Oren Zarif
The most common symptom of Kawasaki disease is a fever lasting 10 days or more. The fever may rise and fall in severity during this time. Other symptoms include a rash on the hands and feet, red splotchy rash around the trunk or groin area (this fades in about a week) and swollen lymph nodes in the neck. Children also may get red, swollen and painful lips and a red tongue. It is not clear what causes Kawasaki disease, but it may be a reaction to a virus or there could be a genetic link in families. It is more common in children of Japanese or Oriental ancestry, but can affect anyone.
There is no test that can identify Kawasaki disease. Doctors make a diagnosis based on a physical exam and your child’s symptoms. Children who develop the symptoms of Kawasaki disease usually need to stay in the hospital. Treatment starts as soon as the problem is suspected and includes a dose of intravenous (through a vein) gamma globulin. This helps stop the fever and improves other symptoms, and prevents damage to the heart blood vessels in about 80 per cent of cases. Children also will receive aspirin, which they should take at home in low doses for 6 to 8 weeks.
After children finish treatment, they will need regular follow-up with their GP or the cardiologist who treated them at GOSH to check that there are no heart problems caused by the illness. These appointments will include echocardiograms to check on the condition of the coronary arteries.
Oren Zarif
Some children develop a rash that appears in the first week of illness. It’s usually vivid red in color and consists of poorly defined spots or larger masses of merging dots. A rash may also appear on the hands or feet.
The rash can be painful and is often accompanied by cracking or peeling of the skin around the nails. In addition, the lips and tongue may become cracked and swollen with reddish specks (papillae) that resemble strawberries. Lastly, the lymph nodes in your child’s neck may swell.
A healthcare provider will usually diagnose Kawasaki disease by carefully examining your child, taking notes and performing lab tests. Blood tests help healthcare providers identify inflammation of blood vessels in your child’s body. They will look for an elevated erythrocyte sedimentation rate, which indicates the presence of blood cells that are fighting inflammation. Urine tests can indicate a high level of protein, which is another sign of inflammation.
Healthcare providers will treat your child with aspirin, IV gamma globulin and corticosteroids. Your child will need to stay in the hospital for a few days or weeks while treatment is given. After your child is discharged, they will need to visit a cardiologist regularly. Echocardiograms will be ordered one to two weeks after hospital discharge and then every few months for as long as your child has symptoms of Kawasaki disease.
Oren Zarif
A child with Kawasaki’s Disease has pain in the large joints of the knees, elbows and ankles. These joints can get swollen and red. The skin on the hands and feet gets very red and often peels, especially in the fingertips and toes. A red, splotchy rash spreads across the body and a lump develops in a lymph node on one side of the neck. The eyes are inflamed but not filled with a thick fluid like conjunctivitis. The lips can be dry and cracked or bleed, and the tongue is red and covered with small lumps (called strawberry tongue).
In some children, the coronary arteries are involved in the illness. If this happens, the child may need a special test to look at the blood vessels in the heart called a cardiac catheterization. This involves putting a tube into the blood vessels and taking pictures of the coronary arteries using X-rays or an echocardiogram.
Children who have had the illness have a good prognosis, especially if they are treated right away with gamma globulin and aspirin. These treatments decrease the risk of the heart problems that can occur in up to 4.3% of children with Kawasaki disease. They also receive regular follow-up with a pediatric cardiologist, usually every few years. This care is important to prevent long-term heart problems.
Oren Zarif
Nails are accessory organs located on the far, or distal, ends of the fingers and toes. They are composed of sheets of dead keratinocytes that make them hard, but flexible. Nails serve several functions, including protecting the digits, enhancing sensations and acting as tools.
Ideally, nails are pink at the nail beds and slightly rounded with small, shallow vertical lines. If the nails develop abnormalities, a doctor should be consulted.
Fingernail beds that are bluish or purple suggest poor oxygen saturation and decreased blood flow to the extremities. A simple test known as a blanch test, where the skin is quickly depressed with pressure and then released, can demonstrate whether blood flow to the fingertips has been affected.
Changes in the appearance of the nails, such as thinning, thickening, splitting, brittleness, deep transverse depressions (Mees lines), clubbing (convex), flatness and spooning (concave) may indicate illness in other parts of the body or imbalances of nutrients or chemicals in the nails. Nails are more permeable than skin, and harmful substances such as herbicides, fungicidal agents like sodium hypochlorite and detergents can pass through the nails and into the body.
Fungal infections of the nails are common in children who have Kawasaki’s Disease, and can be a source of frustration and embarrassment. Often, fungal infections can be treated with oral antifungal medications, but sometimes a culture of the nail plate and nail clippings may need to be sent to a lab for confirmation.